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Case Report

Renal Parenchymal Malakoplakia with Acute Interstitial Nephritis Presented with Acute Kidney Injury

In Mee Han, Youn Kyung Kee, Eunyoung Lee, Choong-kun Lee, Seung Gyu Han, Su Jin Heo, Tae-Hyun Yoo
The Ewha Medical Journal 2015;38(1):36-41. Published online: March 26, 2015

Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

Corresponding author: Tae-Hyun Yoo. Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-749, Korea. Tel: 82-2-2228-1930, Fax: 82-2-393-6884, YOOSY0316@yuhs.ac
• Received: July 17, 2014   • Accepted: September 26, 2014

Copyright © 2015, The Ewha Medical Journal

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Malakoplakia is an uncommon chronic granulomatous inflammatory disease which is associated with immunocompromised conditions such as malignancy, autoimmune disease, chronic alcohol intake, poorly controlled diabetes and long-term steroid use. Malakoplakia can occur at various sites, most commonly in the genitourinary tract including urinary bladder and the ureter. Renal parenchymal involvement is relatively uncommon, accounting for 15% of all malakoplakia. A few cases of renal malakoplakia have been reported in Korea, and only one case was accompanied by acute kidney injury. Here we report an 80-year-old female patient with renal parenchymal malakoplakia and acute interstitial nephritis presented as acute kidney injury with literature review.
  • Keywords: Interstitial nephritis; Acute kidney injury
  • 1. Jung SJ, Kang HC, Choi JJ. Malakoplakia of the kidney extending to the descending colon in a patient with secondary adrenal insufficiency: a case report. Korean J Fam Med 2011;32:367-372.
  • 2. Yoon SY, Lee HJ, An JH, Kim SJ, Kim SW, Woo JH, et al. Renal parenchymal malakoplakia presenting with abscesses and hepatic extension misdiagnosed as a malignant tumor: a case report. Korean J Med 2012;82:764-768.
  • 3. Jo YI, Yoo TS, Heo WM, Yoo JK, Jo HS, Yoo KH, et al. A case of renal malakoplakia with renal insufficiency. Korean J Med 1996;51:843-849.
  • 4. Keitel E, Pegas KL, do Nascimento Bittar AE, dos Santos AF, da Cas Porto F, Cambruzzi E. Diffuse parenchymal form of malakoplakia in renal transplant recipient: a case report. Clin Nephrol 2014;81:435-439.
  • 5. Diwakar R, Else J, Wong V, Carne A, Banerjee D, MacPhee I. Enlarged kidneys and acute renal failure: why is a renal biopsy necessary for diagnosis and treatment? Nephrol Dial Transplant 2008;23:401-403.
  • 6. Cho MH, Chae IY, Kim KB, Rhew HY, Hur B, Huh MH. A case of Malakoplakia with duplex kidney. Korean J Urol 1989;30:250-255.
  • 7. Hong JH, Kim HJ, Kim CS, Ahn TJ, Ahn TY, Kim KH. Malacoplakia in genitourinary tract: 2 cases. Ulsan Univ Med J 1992;1:212-216.
  • 8. Jung SS, Joo YS, Jin JY, Jung DR, Moon HB, Kim KH, et al. A case of renal parenchymal malakoplakia associated with E: coli empyema. Korean J Infect Dis 1993;25:277-281.
  • 9. Kim SE, Noh TW, Kown KW, Jeong HJ, Kim YS, Kim SI, et al. Malakoplakia in a renal allograft: a case report. J Korean Soc Transplant 2001;15:256-258.
  • 10. Jeong YH, Kim DJ, Kim JH, Lee HJ, Jang GD, Kim EK, et al. Bilateral renal parenchymal malacoplakia presenting as fever and acute renal failure. Korean J Nephrol 2001;20:530-534.
  • 11. Sung DE, Yu E, Kim CS, Ro JY. Renal malakoplakia with secondary hepatic extension: a case report. Korean J Pathol 2003;37:199-203.
  • 12. Tam VK, Kung WH, Li R, Chan KW. Renal parenchymal malacoplakia: a rare cause of ARF with a review of recent literature. Am J Kidney Dis 2003;41:E13-E17.
Fig. 1

Abdomino-pelvic CT on admission. It demonstrates multifocal attenuation differences at both kidneys (A) and normal-sized kidneys without hydronephrosis (B).

emj-38-36-g001.jpg
Fig. 2

Renal biopsy specimen they show (A) localized moderate fibrosis with dense histiocytic infiltrates, (B) mild lymphoplasma cell and eosinophilic infiltrates, (C) foam cells surrounding the interstitium and tubules (H&E, ×200), and (D) histiocytes with round concentric layered intracytoplasmic Michaelis-Gutmann bodies (Periodic acid-Schiff, ×200).

emj-38-36-g002.jpg
Fig. 3

Immunohistochemical stain. It demonstrates strong reactivity for CD68 (A, ×40; B, ×200).

emj-38-36-g003.jpg
Fig. 4

Trends in serum creatinine and Creactive protein during follow-up period.

emj-38-36-g004.jpg
Table 1

Summary of reported cases of renal malakoplakia in Korea

BUN, blood urea nitrogen; Cr, serum creatinine level; WBC, white blood cell count; RA, rheumatoid arthritis; HTN, hypertension; DM, diabetes mellitus; NM, not mentioned; E.coli, Escherichia coli; CVA, cerebrovascular accident; CLD, chronic liver disease; TMP/SMX, trimethoprim/sulfamethoxazole; CP, chronic pancreatitis; IgAN, IgA nephropathy; Tx, treatment; OA, osteoarthritis; WNL, within normal limits; MG, Myasthenia gravis; PD, Parkinson' s disease.

emj-38-36-i001.jpg

Figure & Data

Fig. 1

Abdomino-pelvic CT on admission. It demonstrates multifocal attenuation differences at both kidneys (A) and normal-sized kidneys without hydronephrosis (B).

emj-38-36-g001.jpg
Fig. 2

Renal biopsy specimen they show (A) localized moderate fibrosis with dense histiocytic infiltrates, (B) mild lymphoplasma cell and eosinophilic infiltrates, (C) foam cells surrounding the interstitium and tubules (H&E, ×200), and (D) histiocytes with round concentric layered intracytoplasmic Michaelis-Gutmann bodies (Periodic acid-Schiff, ×200).

emj-38-36-g002.jpg
Fig. 3

Immunohistochemical stain. It demonstrates strong reactivity for CD68 (A, ×40; B, ×200).

emj-38-36-g003.jpg
Fig. 4

Trends in serum creatinine and Creactive protein during follow-up period.

emj-38-36-g004.jpg
Table 1

Summary of reported cases of renal malakoplakia in Korea

BUN, blood urea nitrogen; Cr, serum creatinine level; WBC, white blood cell count; RA, rheumatoid arthritis; HTN, hypertension; DM, diabetes mellitus; NM, not mentioned; E.coli, Escherichia coli; CVA, cerebrovascular accident; CLD, chronic liver disease; TMP/SMX, trimethoprim/sulfamethoxazole; CP, chronic pancreatitis; IgAN, IgA nephropathy; Tx, treatment; OA, osteoarthritis; WNL, within normal limits; MG, Myasthenia gravis; PD, Parkinson' s disease.

emj-38-36-i001.jpg

References

  • 1. Jung SJ, Kang HC, Choi JJ. Malakoplakia of the kidney extending to the descending colon in a patient with secondary adrenal insufficiency: a case report. Korean J Fam Med 2011;32:367-372.
  • 2. Yoon SY, Lee HJ, An JH, Kim SJ, Kim SW, Woo JH, et al. Renal parenchymal malakoplakia presenting with abscesses and hepatic extension misdiagnosed as a malignant tumor: a case report. Korean J Med 2012;82:764-768.
  • 3. Jo YI, Yoo TS, Heo WM, Yoo JK, Jo HS, Yoo KH, et al. A case of renal malakoplakia with renal insufficiency. Korean J Med 1996;51:843-849.
  • 4. Keitel E, Pegas KL, do Nascimento Bittar AE, dos Santos AF, da Cas Porto F, Cambruzzi E. Diffuse parenchymal form of malakoplakia in renal transplant recipient: a case report. Clin Nephrol 2014;81:435-439.
  • 5. Diwakar R, Else J, Wong V, Carne A, Banerjee D, MacPhee I. Enlarged kidneys and acute renal failure: why is a renal biopsy necessary for diagnosis and treatment? Nephrol Dial Transplant 2008;23:401-403.
  • 6. Cho MH, Chae IY, Kim KB, Rhew HY, Hur B, Huh MH. A case of Malakoplakia with duplex kidney. Korean J Urol 1989;30:250-255.
  • 7. Hong JH, Kim HJ, Kim CS, Ahn TJ, Ahn TY, Kim KH. Malacoplakia in genitourinary tract: 2 cases. Ulsan Univ Med J 1992;1:212-216.
  • 8. Jung SS, Joo YS, Jin JY, Jung DR, Moon HB, Kim KH, et al. A case of renal parenchymal malakoplakia associated with E: coli empyema. Korean J Infect Dis 1993;25:277-281.
  • 9. Kim SE, Noh TW, Kown KW, Jeong HJ, Kim YS, Kim SI, et al. Malakoplakia in a renal allograft: a case report. J Korean Soc Transplant 2001;15:256-258.
  • 10. Jeong YH, Kim DJ, Kim JH, Lee HJ, Jang GD, Kim EK, et al. Bilateral renal parenchymal malacoplakia presenting as fever and acute renal failure. Korean J Nephrol 2001;20:530-534.
  • 11. Sung DE, Yu E, Kim CS, Ro JY. Renal malakoplakia with secondary hepatic extension: a case report. Korean J Pathol 2003;37:199-203.
  • 12. Tam VK, Kung WH, Li R, Chan KW. Renal parenchymal malacoplakia: a rare cause of ARF with a review of recent literature. Am J Kidney Dis 2003;41:E13-E17.

Citations

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  • Bladder Malakoplakia Mimicking Bladder Cancer
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Renal Parenchymal Malakoplakia with Acute Interstitial Nephritis Presented with Acute Kidney Injury
Ewha Med J. 2015;38(1):36-41.   Published online March 26, 2015
DOI: https://doi.org/10.12771/emj.2015.38.1.36
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Renal Parenchymal Malakoplakia with Acute Interstitial Nephritis Presented with Acute Kidney Injury
Ewha Med J. 2015;38(1):36-41.   Published online March 26, 2015
DOI: https://doi.org/10.12771/emj.2015.38.1.36
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Renal Parenchymal Malakoplakia with Acute Interstitial Nephritis Presented with Acute Kidney Injury
Image Image Image Image
Fig. 1 Abdomino-pelvic CT on admission. It demonstrates multifocal attenuation differences at both kidneys (A) and normal-sized kidneys without hydronephrosis (B).
Fig. 2 Renal biopsy specimen they show (A) localized moderate fibrosis with dense histiocytic infiltrates, (B) mild lymphoplasma cell and eosinophilic infiltrates, (C) foam cells surrounding the interstitium and tubules (H&E, ×200), and (D) histiocytes with round concentric layered intracytoplasmic Michaelis-Gutmann bodies (Periodic acid-Schiff, ×200).
Fig. 3 Immunohistochemical stain. It demonstrates strong reactivity for CD68 (A, ×40; B, ×200).
Fig. 4 Trends in serum creatinine and Creactive protein during follow-up period.

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Renal Parenchymal Malakoplakia with Acute Interstitial Nephritis Presented with Acute Kidney Injury

Summary of reported cases of renal malakoplakia in Korea

BUN, blood urea nitrogen; Cr, serum creatinine level; WBC, white blood cell count; RA, rheumatoid arthritis; HTN, hypertension; DM, diabetes mellitus; NM, not mentioned; E.coli, Escherichia coli; CVA, cerebrovascular accident; CLD, chronic liver disease; TMP/SMX, trimethoprim/sulfamethoxazole; CP, chronic pancreatitis; IgAN, IgA nephropathy; Tx, treatment; OA, osteoarthritis; WNL, within normal limits; MG, Myasthenia gravis; PD, Parkinson' s disease.
Table 1 Summary of reported cases of renal malakoplakia in Korea

BUN, blood urea nitrogen; Cr, serum creatinine level; WBC, white blood cell count; RA, rheumatoid arthritis; HTN, hypertension; DM, diabetes mellitus; NM, not mentioned; E.coli, Escherichia coli; CVA, cerebrovascular accident; CLD, chronic liver disease; TMP/SMX, trimethoprim/sulfamethoxazole; CP, chronic pancreatitis; IgAN, IgA nephropathy; Tx, treatment; OA, osteoarthritis; WNL, within normal limits; MG, Myasthenia gravis; PD, Parkinson' s disease.

Table 1

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